Category Archives: Uncategorised

Case 151 – The final update

This child underwent an allogenic stem cell transplant. He had to be treated for his HLH initially. Part of it involved chemotherapy (FLA) as JMML was the underlying cause driving the HLH. The choice between ‘watch and wait ‘ vs … Continue reading

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Case 151 – Update 3

So , the diagnosis is JMML – Juvenile myelomonocytic leukemia. We will have a summary later but just a few brief points to note : JMML is unique aggressive myeloproliferative/myelodysplastic disorder of infancy and early childhood caused by proliferation of … Continue reading

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Case 151 – Update 2

Going forward , we test and rule out other underlying problems : Genetic mutation for primary HLH is negative Workup for organic acidemias and inborn errors are negative Extended viral panel and AFB does not help There is no evidence … Continue reading

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Case 151 – Update 1

Thanks a lot for your responses. Fevers continue despite good antibiotic cover. All cultures are sterile. Lymphadenopathy persists and he has ongoing splenomegaly. Peripheral blood is sent for flow cytometry. There is only 1% of CD 45 weak population positive … Continue reading

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Case 151 – The Begining

It is a friday afternoon and as the haematology registrar who has had a busy on call, the weekend looks quite inviting. The phone rings and it is the Paediatric SHO. There is a 7 month old boy who has … Continue reading

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Case 150 – summary

This week we discussed the case of a young lady with eosinophilia. She had some vague symptoms to begin with, but after thorough investigation, she was found to have disseminated strongyloidiasis complicated by E. coli bacteraemia. She was immunosuppressed due … Continue reading

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Case 150 – update 5

Stool examination (wet mount) reveals a filariform larva of Strongyloides stercoralis – thus making the diagnosis disseminated strongyloidiasis secondary to HIV infection. She is commenced on ivermectin and starts to improve. She has also been referred to the infectious diseases … Continue reading

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Case 150 – update 4

You receive a phone call from a very excited microbiologist, saying they’ve found something in this lady’s stools! See image below What is this and how would you treat it?

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Case 150 – update 3

Our patient’s seizure was short lived and self-terminated. Her blood cultures grow E. coli. CT head is clear. She undergoes a lumbar puncture and the microbiology lab are able to see Gram negative bacilli in her CSF. She is commenced … Continue reading

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Case 150 – update 2

Our patient has been admitted for further investigations. You feel she does not require urgent steroid therapy at this point. You have arranged for peripheral blood cytogenetics looking for common mutations associated with primary eosinophilia. You also organise a vasculitis … Continue reading

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Case 150 – update 1

You advise the GP to refer to the haematology clinic in view of her eosinophilia and unexplained weight loss. When you see her clinic after about 4 weeks, she looks unwell. She tells you she has lost about 3kg in … Continue reading

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Case 150 – the beginning

A 29 year old lady sees her GP due to feeling generally unwell. She thinks she has lost some weight over the last few weeks, and has also had cold type symptoms during that time (sore throat, runny nose, fatigue). … Continue reading

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Case 149- summary

This weeks case focussed on the importance frailty assessment in making treatment decisions for an elderly patient with Diffuse large B cell lymphoma. This is an important topic as DLBCL affects an older population with mean age at diagnosis of … Continue reading

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Case 149 – Update 1

  Our patient is a retired cleaner who lives in a house next to her only daughter and her two grand-children. She is a non smoker and drinks no alcohol. She tells you that her daughter tended to do the … Continue reading

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Case 149 – The Beginning

You are the on call haematology registrar working at a District general hospital when you receive a call from the medical team at 4pm on a friday. They have an 87 year old lady with neck lymphadenopathy that has grown … Continue reading

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Case 148 conclusion and summary

The patient is treated for serum sickness. Given the severity of the symptoms, he is given another pulse of methylprednisolone and converted back to oral prednisolone. He is also treated supportively with analgesia and antipyretics, as well as platelet transfusions. … Continue reading

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Case 148: update 3

HLA typing of this patient’s two siblings has not identified a match. Unfortunately, unrelated donor search has not identified any suitable donors. The patient is consented to immunosuppressive therapy with horse ATG and ciclosporin. The patient is admitted and receives … Continue reading

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Case 148: update 2

The patient is admitted for broad spectrum antibiotics and red cell transfusion. A bone marrow biopsy is performed, which demonstrates 10% cellularity with no dysplastic features, no excess of blasts, no abnormal infiltrate and no fibrosis. Cytogenetics demonstrate a normal … Continue reading

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Case 148: update 1

The gastroenterology team have kindly organised further investigations. B12 and folate are normal, viral serology (including HIV, CMV, EBV and parvovirus) are all negative. Autoantibody screen was also negative. LDH is normal and there is no evidence of haemolysis. Peripheral … Continue reading

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Case 148: the beginning

You are the liaison haematology registrar and receive a call from the gastroenterology team for advice about a 24 year old male patient under their care. He is a previously fit and well university student who initially presented 3 months … Continue reading

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